# Measuring the Value of Improving Access to Community Care

> **NIH VA I01** · VA PUGET SOUND HEALTHCARE SYSTEM · 2022 · —

## Abstract

Background: Providing timely access to health care has been a long-standing VA goal that has been re-
emphasized by the Commission on Care. To improve access to care, VA implemented the Veterans Choice
Program in August 2014, which provides eligible Veterans the option of receiving care from community
providers paid for by VA. Currently, there is a substantial gap in scientific evidence on the effect of the Choice
Program and other VA community care programs, particularly in regards to the degree the program has
improved access to care. More generally, non-VA literature examining the effect of greater provider options
has focused on changes in utilization, but has not assessed the value of improved patient choice. The
development of measures that capture the value of greater provider options is methodologically challenging
because patients’ preferences are not directly observed and value encompasses many dimensions of access
(e.g., travel distance, appointment wait times, provider quality, etc.). To address these evidence gaps, we
propose the development and examination of new measures capturing the value of provider options to
Veterans using state-of-the art econometric methods. Greater scientific evidence to help VA provide enhanced
choice for Veterans through the Choice Program and future VA community care programs is consistent with
the VHA FY 2018-2019 Operational Plan. This study addresses the ORD-wide Learning Health Care System
priority area and HSR&D’s Access and Health Care Systems Change major priority domains.
Objectives: The objectives of this study are to: 1) develop new econometric method applications to
quantitatively measure the value of greater access to providers from the perspective of Veterans and 2)
examine the relative importance of local area and provider characteristics in determining Veterans’ value of
having improved access to providers.
Methods: This observational study will examine VA administrative data and existing public data characterizing
outpatient providers. In Aim 1, we will use VA administrative data to identify: 1) Veterans eligible for the VA
Choice Program in 2016, 2) VA and Choice outpatient providers and 3) utilization of outpatient services from
VA facilities and through the Choice Program. We will analyze Veterans’ revealed preference for providers
using econometric random utility models. These models assume patients select the provider that yields the
greatest benefit, given all available options. We will empirically estimate Veterans’ choice of provider within the
random utility framework using a nested multinomial logit model (NMNL). We will then use parameter
estimates and predictive margins from the NMNL model to calculate the value of greater provider options
through the Choice Program. Specifically, econometric models will calculate Veterans’ willingness to pay
(WTP), which represents the maximum dollar amount an individual would theoretically pay for greater provider
options. In Aim 2, we will ...

## Key facts

- **NIH application ID:** 10209957
- **Project number:** 5I01HX002540-03
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Edwin S. Wong
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-06-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10209957

## Citation

> US National Institutes of Health, RePORTER application 10209957, Measuring the Value of Improving Access to Community Care (5I01HX002540-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10209957. Licensed CC0.

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